Project 2025's reproductive health agenda: Hyde audits, EMTALA reversal, and Section 1303 enforcement
Project 2025 targets abortion access through multiple federal levers: reinstating stricter separate payment requirements under ACA Section 1303, auditing Hyde Amendment compliance across HHS programs, rescinding the 2022 EMTALA guidance that protects emergency abortion care, and codifying permanent Hyde and Weldon restrictions. These actions would strip coverage, criminalize providers, and endanger patients in states with abortion bans.
Project 2025 treats abortion access as a compliance problem to be solved through audits, narrower regulations, and permanent statutory bans. It wants HHS to reinstate a Trump-era rule requiring insurers to collect separate payments for abortion coverage in ACA plans — a bureaucratic hurdle that reduces plan availability and drives up costs for patients. It calls for a full Hyde Amendment audit across every HHS program, targeting post-Dobbs executive actions and Medicaid managed care plans in states that protect abortion rights. And it demands rescission of the 2022 EMTALA guidance that requires hospitals to provide abortion care when necessary to stabilize an emergency — a protection that has been crucial in states where abortion is now banned.
The EMTALA reversal is particularly dangerous. In the wake of Dobbs, pregnant people in states with near-total bans have died or suffered severe complications because physicians feared prosecution for providing standard miscarriage management, ectopic pregnancy treatment, or abortion to prevent sepsis. The 2022 HHS guidance made clear that EMTALA overrides state bans in emergencies; rescinding it would leave patients at the mercy of whatever patchwork state legislatures decide — and would also end DOJ enforcement actions against states that block emergency care. This is not abstract: it means preventable deaths.
Meanwhile, Project 2025 wants Congress to permanently codify the Hyde and Weldon amendments, locking into place a ban on federal funding for abortion that has been renewed annually for decades. Permanent codification would eliminate any future Congress's ability to stop using the appropriations process to restrict abortion coverage — a procedural change that would entrench coverage gaps for low-income people on Medicaid, CHIP, and the Indian Health Service. Combined with the proposed audits and the Section 1303 enforcement, the goal is to make abortion effectively inaccessible for anyone who relies on federal health programs.
The humanitarian alternative
Congress should pass the Women's Health Protection Act to codify abortion rights nationally and the EACH Act to repeal Hyde restrictions, while HHS strengthens EMTALA enforcement and Section 1557 protections for all reproductive care.
Grounded in
- Section 1303 of the Affordable Care Act
- Hyde Amendment History and Application
- EMTALA Abortion Guidance from HHS (July 2022)
- Trump Administration EMTALA Abortion Regulation Efforts
- No Taxpayer Funding for Abortion Act (Hyde Codification)
- Conscience Protection Act (Weldon Amendment Codification)
- HHS Section 1557 Rule on Sex Discrimination (2022)
Original source — excerpted
project2025 Project 2025 ch. 15: Department of Housing and Urban Development (pp 506-508)"— 473 — Department of Health and Human Services l Rewrite the ACA abortion separate payment regulation. Section 1303 of Obamacare requires that insurers collect a separate payment for certain abortion coverage in qualified health plans that are approved to be sold on exchanges and that they keep those separate payments in separate accounts that are used only to pay for elective abortion services. Neither the letter nor the spirit of the law was enforced under President Obama, and a Trump- era regulation sought to correct this problem. The Biden HHS rescinded this regulation to allow insurance companies once again—contrary to the law—to collect combined payments for what are clearly required to be separate payments for elective abortion coverage. “Separate” does not mean “together.” HHS should reinstate a Trump Administration regulation and enforce what the plain text of Section 1303 requires. That regulation should be further improved by requiring CMS to ensure that consumers pay truly separate charges for abortion coverage. l Audit Hyde Amendment compliance. HHS should undertake a full audit to determine compliance or noncompliance with the Hyde amendment and sim…"